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HomeMy WebLinkAbout0019 DACEY DRIVE - Health (2) C� oc Cc APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION WOWS' . 35 ,��--�� UZ�VS" N0.P, f,. VILLAGE HYA.i4JLS C vlt.�s APPLICANT� DATEeLZ�/SIDC�VIIAUJ� �. �uC FEE l%ADDRESS <G'b TELEPHONE NO. `)7/-10� (Non-refs+nd b ENGINEER )CCb2_ �✓•, yp L TELEPHONE Np. 0L�•Zg-9/151 TE DA •;`SCHEDULED 2S2�j) (APPlicant' s signature) ASSLSSOR'S�MAP"& LOT NO* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . s. . . . . . . . . . . . . . o. . o . . . . . 1��/ SOIL_ LOG SUB-DIVISION {`NAME JS(� WOO-Ds DATE EXPANSION ARLA: , YES ✓.:NO ' ' TIME TOWN i�ATER ✓PRIVATE WELL ENGINEER:'R' ' BOARD OF HEAL? SKETCH: (street name EXCAVATOR , etc-tests, lot, exact location of test holes percolation , locate wetlands in proximity to test hol and ,•. NOTES : 0 d _ Si��-ems li ?ERCOLATION RATE:�'114 MrIJ a/d. �55 'PEST HOLE N0: ' ELEVATION: 1 TEST HOLE N0: ELEVATION: 2 L+5 2 3 3 4 6 S � 5 g . 9 B 10 g 10 12 13 12 14 . 13 15 14 .16 15 ' ' SUITABLE 'FOR. SUB-SURFACE SEWAGE: .. 16 LEA CHING FIELD_ LEA NG PITS °® LEACHING TREN;CHE `UNSUITABLE FOR 'SUB-SURFACE SEWAGE. REASONS: NOTE : ENG,INEEIRING PLANS MUST SHOW NUMBER• ASSIGNED .ON PERC TEST APPLICATION URIGINAI,': COtiPLETED N ENT RE P COPX:. RETAINED BY APPLICANT RNED TO BOARD OF HEALTH